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NAPLEX 2023 > Chapter 64: Schizophrenia/Psychosis > Flashcards

Chapter 64: Schizophrenia/Psychosis Flashcards

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1
Q

Schizophrenia cause is multifactorial and includes altered brain structure and chemistry, primarily involving _____, ____ and _____

A

DA, serotonin, and glutamine

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2
Q

Common symptoms of schizophrenia

A

Hallucinations
Delusions
Disorganized thinking/behavior

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3
Q

Negative Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Loss of interest in everyday activities
  • Lack of emotion (apathy)
  • Inability to plan or carry out activities
  • Poor hygiene
  • Social withdrawal
  • Loss of motivation (avolition)
  • Lack of speech (alogia)
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4
Q

Positive Signs and Symptoms of schizophrenia according to the DSM-5 include

A
  • Hallucinations: can be auditory (hearing voices), visual or somatic
  • Delusions: beliefs held by the patient that are without a basis in reality
  • Disorganized thinking/behavior
  • Difficulty paying attention
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5
Q

Antipsychotics primarily bock which receptors

A

DA and serotonin

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6
Q

What are dystonias?

treatment/ppx?

A

prolonged contractions of muscels during drug initiation
life-threatening if airway is compromised

centrally acting anticholinergics (diphenhydramine/benztropine)

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7
Q

What is akathisia?

how to treat

A

restlessness wth anxiety and an inability to remain still

treated iwth BZD or propranolol

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8
Q

What is parkinsonism?

how to treat

A

looks like parkisons (tremors, abnormal gait, bradykinesia)

treat with anticholinergics or propranolol (for tremor)

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9
Q

What is tardive dyskinesias?

treatment

A

abnormal facial movements (tongue/mouth)
can be irreversible

STOP drug, replace with SGA with lower EPS risk (quetiapine / clozapine)

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10
Q

What are dyskinesias?

A

abnormal movements
common with dopamine replacement in parkinson disease

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11
Q

What drug class is used first line in schizophrenia & why

A

Second-generation antipsychotics (SGA); they have a lower risk of extrapyramidal symptoms

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12
Q

Medications/illicit drugs that can cause psychotic symptoms

A
  • Anticholinergics (centrally-acting, high doses)
  • Dextromethorphan
  • DA or DA agonists (e.g., Requip, Mirapex, Sinemet)
  • Interferons
  • Stimulants
  • Systemic steroids
  • Illicit drugs include bath salts, cannabis, cocaine, LSD, methylphenidate/ice/crystal, PCP
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13
Q

FGAs have a high incidence of EPS, including ____, ______, ______, and _____

A
  • painful dystonias (muscle contractions)
  • dyskinesias (abnormal movements)
  • tardive dyskinesias (repetitive, involuntary movements such as grimacing and eye blinking)
  • akathisia (restlessness, inability to remain still)
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14
Q

Tardive dyskinesias (TD) can be irreversible; the drug causing the TD should be ____

A

discontinued

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15
Q

Which two drugs should not be given together (i.e., in an injection) d/t risk of excessive sedation and breathing difficulty

A

Olanzapine and benzodiazepines

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16
Q

There is an increased risk of mortality when antipsychotics are used for ____ in elderly with dementia-related psychosis

A

agitation control

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17
Q

use of antipsychotics in elderly patietns with dementia-related psychosis can lead to

A

increased risk of mortality –> CV conditions

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18
Q

Several antipsychotics also carry a warning for an increased risk of ____ in patients with dementia

A

stroke

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19
Q

First-generation antipsychotic MOA

A

work mainly by blocking dopamine-2 (D2) receptors, with minimal serotonin receptor blockade

many are in phenothiazine class = “azine” ending

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20
Q

Thioridazine boxed warning

A

QT prolongation

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21
Q

Which FGAs have a warning for QT prolongation

A

thioridazine, haloperidol, chlorpromazine

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22
Q

Besides QT prolongation, what are other warnings for FGAs

A

orthostasis/falls, anticholinergic effects, CNS depression, EPS, hyperprolactinemia, neuroleptic malignant syndrome (NMS)

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23
Q

Side effects of FGAs

A

Sedation, dizziness, anticholinergic effects, increased prolactin, EPS

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24
Q

What medication class can you give with FGAs to limit/avoid painful dystonic reactions

A

Anticholinergics (e.g., benztropine, diphenhydramine)

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25
(higher or lower) potency drugs have ↑ sedation and ↓ EPS
Lower
26
(higher or lower) potency drugs have ↓ sedation and ↑ EPS
Higher
27
Haloperidol brand name
Haldol
28
Haldol Decanoate is given how often and via what route
IM monthly
29
what class is haloperidol in structurally?
butyrophenone
30
Fluphenazine decanoate is given how often and via what route
IM every 2 weeks
31
Second generation antipsychotic MOA
work mainly by blocking dopamine-2 (D2) receptors & serotonin (5-HT2A) receptors
32
Aripiprazole brand name
Abilify
33
Abilify Maintena is an IM suspension given every ____
month
34
Aristada (Abilify) is an IM suspension given every ____
4-8 weeks
35
Clozapine brand name
Clozaril
36
Clozapine is very effective and has ↓ risk of EPS/TD, but used no sooner than ___ line due to severe SE potential (metabolic effects, neutropenia)
3rd
37
Clozapine boxed warning
- Significant risk of potentially life-threatening neutropenia/agranulocytosis (REMS program) - Myocarditis and cardiomyopathy: d/c if suspected - Seizures
38
Clozapine side effects
Agranulocytosis, seizures, constipation, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids), hypersalivation
39
Abilify side effects
Akathisia, activating
40
Which SGA requires REMS program
Clozapine
41
To start clozapine treatment, baseline ANC must be | how often to check ANC
≥ 1500/mm3 | baseline, qweek x 6 months, q2weeks x 6 months, then monthly
42
Clozapine therapy must be stopped if ANC falls below
< 1000/mm3
43
Lurasidone brand name
Latuda
44
Lurasidone side effects
Somnolence, EPS (dystonias), nausea | - Nearly weight, lipid and glucose neutral
45
Olanzapine brand name
Zyprexa
46
Zyprexa Relprevv injection suspension lasts ____
2-4 weeks
47
Zyprexa Relprevv injection can cause sedation (including coma) and delirium following injection & must be administered in a registered healthcare facility. Patients must be monitored for ____ post-injection (REMS program requirements)
3 hours
48
Olanzapine side effects
Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
49
Paliperidone brand name
Invega, Invega Sustenna (monthly), Invega Trinza (q3mo), Hafyera (q6mo)
50
How often is Invega Sustenna IM injection given
monthly
51
How often is Invega Trinza IM injection given and when should it be started
every 3 months; start only after receiving Invega Sustenna x 4 months | tri = three
52
How often is Invega Hafyera IM injection given?
every 6 months | hafyera = Half a year
53
Paliperidone side effects
- ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods - EPS, especially at higher doses - Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
54
Quetiapine brand name
Seroquel
55
Quetiapine SE
- Somnolence, metabolic syndrome (↑ weight, ↑ BG, ↑ lipids) | - Low EPS risk- often used for psychosis in PD
56
When should Seroquel XR be taken and how
At night, without food or with a light meal
57
Risperidone brand name
Risperdal, Risperdal Consta (q2weeks)
58
How often is Risperdal Consta IM injection given
every 2 weeks
59
Risperidone SE
- ↑ prolactin – sexual dysfunction, galactorrhea, irregular/missed periods - EPS, especially at higher doses - Metabolic syndrome (↑ weight, ↑ BG, ↑ lipids)
60
Ziprasidone brand name
Geodon
61
Should ziprasidone be taken with or without food
with food | Zip past the pantry and get some food before taking
62
Ziprasidone CI
QT prolongation: do not use with QT risk
63
What SGA comes as a sublingual tablet
Asenapine (Saphris)
64
Counseling for Asenapine (Saphris)
No food/drink for 10 min after dose may cause tong numbness
65
Which antipsychotics can cause increased prolactin, leading to painful gynecomastia
Risperidone, paliperidone
66
Which SGA can cause painful dystonia and tardive diskinesia
Haloperidol
67
Which SGAs have cardiac risk/QT prolongation
Ziprasidone, haloperidol, thioridazine, chlorpromazine
68
Which SGAs have high risk of EPS
Risperidone, paliperidone (at high doses)
69
Which SGA should you give someone if they have history of movement disorder (e.g., Parkinson's Disease)
Quetiapine
70
Which SGAs worsen metabolic issues
Olanzapine, quetiapine
71
Which SGAs are preferred in overweight/metabolic risk (e.g., increased TG)
Aripiprazole, Ziprasidone, lurasidone, and asenapine
72
Which antipsychotics should be given in someone who has acute psychosis and refusing PO meds
Haloperidol IV or IM Alternatives: Ziprasidone IM Olanzapine IM
73
Which SGAs come as ODT
Aripiprazole, olanzapine, risperidone
74
Which SGAs come as oral liquids
Aripiprazole, fluphenazine, haloperidol, risperidone
75
Which SGA comes as a patch
Asenapine
76
Which SGAs can cause hyperglycemia and weight gain
Olanzapine, quetiapine, risperidone, and paliperidone
77
Risperidone oral solution cannot be mixed with
Cola or tea
78
What is the first drug that has been approved for tardive diskinesia
Valbenazine (Ingrezza)
79
Valbenazine warnings
Somnolence
80
Deutetrabenzine, another drug approved for tardive diskinesia, has a CI for
Hepatic impairment
81
Neuroleptic malignant syndrome (NMS) is rare, but highly lethal. It occurs commonly with FGAs and is due to
D2 blockade
82
Signs of NMS include
- Hyperthermia - Extreme muscle rigidity (called “lead pipe” rigidity), which can lead to respiratory failure - Mental status changes - Other signs can include tachycardia, tachypnea, and BP changes
83
How do you treat NMS
- Taper off the antipsychotic quickly and consider another choice (quetiapine or clozapine) - Provide supportive care - Cool the pt down - Muscle relaxation with BZDs or dantrolene is sometimes used, as some cases may require a DA agonist such as bromocriptine

NAPLEX 2023 (88 decks)

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